JAN

JOURNAL OF ADVANCED NURSING

THEORETICAL PAPER

Transition shock: the initial stage of role adaptation for newly

graduated Registered Nurses
Judy E. Boychuk Duchscher
Accepted for publication 17 October 2008

Correspondence to J.E.B. Duchscher:

e-mail: judy.eldon.duchscher@shaw.ca

D U C H S C H E R J . E . B . ( 2 0 0 9 ) Transition shock: the initial stage of role adaptation

for newly graduated Registered Nurses. Journal of Advanced Nursing 65(5), 1103
1113.

Judy E. Boychuk Duchscher MN PhD RN

Facilitator of Scholarly Programs and
Projects
Saskatchewan Institute for Applied Science
and Technology, Saskatoon, Canada

doi: 10.1111/j.1365-2648.2008.04898.x

Abstract
Title. Transition shock: the initial stage of role adaptation for newly graduated
Registered Nurses.
Aim. The aim of this paper is to provide a theoretical framework of the initial
role transition for newly graduated nurses to assist managers, educators and
seasoned practitioners to support and facilitate this professional adjustment
appropriately.
Background. The theory of Transition Shock presented here builds on Kramers
work by outlining how the contemporary new graduate engaging in a professional practice role for the first time is confronted with a broad range and
scope of physical, intellectual, emotional, developmental and sociocultural
changes that are expressions of, and mitigating factors within the experience of
transition.
Data sources. This paper offers cumulative knowledge gained from a programme of
research spanning the last 10 years and four qualitative studies on new graduate
transition.
Discussion. New nurses often identify their initial professional adjustment in terms
of the feelings of anxiety, insecurity, inadequacy and instability it produces. The
Transition Shock theory offered focuses on the aspects of the new graduates roles,
responsibilities, relationship and knowledge that both mediate the intensity and
duration of the transition experience and qualify the early stage of professional role
transition for the new nursing graduate.
Conclusion. Transition shock reinforces the need for preparatory theory about
role transition for senior nursing students and the critical importance of bridging undergraduate educational curricula with escalating workplace expectations. The goal of such knowledge is the successful integration of new nursing
professionals into the stressful and highly dynamic context of professional
practice.
Keywords: acute care, adaptation, Registered Nurses, professional practice,
reality shock, transition shock

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J.E.B. Duchscher

Introduction
These are challenging times for new nursing graduates (NGs),
the majority of whom make their initial transition to
professional practice within the hospital environment. It has
been claimed that <50% of practising nurses would currently
recommend nursing as a career option (Heinrich 2001), while
25% would actively discourage someone from going into
nursing (Baumann et al. 2004, p. 13). It is not surprising,
then, that 3361% of new recruits in North America change
their place of employment or plan to leave nursing altogether
within their first year of professional practice (Dearmun 2000,
Winter-Collins & McDaniel 2000, Advisory Committee on
Health Human Resources 2002, Cowin 2002, Buchan &
Calman 2004, Bowles & Candela 2005).
The importance of exploring the process of NG adaptation
to professional practice in acute-care nursing relates to the
ongoing challenge to healthcare institutions, schools of higher
learning and policy-makers both to understand and respond
to the issues that may be driving these energetic and
motivated nurses out of acute care, or out of the nursing
profession altogether. While it is clear that the journey of
transition for the NG is often stressful, frustrating, discouraging and disillusioning, what remains unclear are the stages
of that journey. Transition shock is presented here as the
most immediate, acute and dramatic stage in the process of
professional role adaptation for the NG. The design of this
stage subsumes elements of transition theory, reality shock,
cultural and acculturation shock, as well as theory related to
professional role adaptation, growth and development, and
change theory.

Background
William Bridges (1980) begins his seminal dialogue on the
concept of transition with this excerpt from Alice in
Wonderland: Who are you? said the caterpillar I - I
hardly know, Sir, just at present, Alice replied rather shyly,
at least I know who I was when I got up this morning, but I
think I must have been changed several times since then
(Carroll 1967, p. 47). Illustrated so poignantly here, transition represents that confusing nowhere of in-betweenness
(Bridges 1980, p. 5) that serves as the channel between what
was and what is. The in-between ness that is the initial
transition from student to professional practitioner is the
subject of this paper.
The experience of transition to professional practice for the
NG has been most notably and historically studied by
Kramer (1974), who coined the term reality shock to describe
the discovery that school-bred values conflicted with work1104

world values. Disturbing discrepancies between what graduates understand about nursing from their education and
what they experience in the real world of healthcare service
delivery leaves NGs with a sense of groundlessness (Duchscher 2001, 2003a, Delaney 2003). Once in the hospital
environment, the new nurse is immersed in a firmly
entrenched, distinctively symbolic and hierarchical culture
that exposes them to dominant normative behaviours that
have been described as prescriptive, intellectually oppressive
and cognitively restrictive (Kramer 1966, Crowe 1994,
Duchscher 2001). Mohr (1995) claimed that the hospital
environment moves NGs away from the ideal of professional
nursing practice adopted by them in their educational
socialization process, and towards a more productivity,
efficiency and achievement-oriented context that emphasizes
institutionally imposed social goals. Resulting role ambiguity
and the internal conflict that it precipitates have been cited as
turning the creative energy of these new nurses into job
dissatisfaction and career disillusionment (Gerrish 2000,
Greenwood 2000, Winter-Collins & McDaniel 2000, Duchscher 2001, 2003a, Chang & Hancock 2003).
Existing knowledge suggests that NGs experience role
performance stress, moral distress, discouragement and
disillusionment during the initial months of their introduction
to professional nursing practice in acute care. What remains
less clear are the relationships between these experiences and
the passage of time. While I found prior evidence on the
experience of transition, no researchers seem to have extrapolated that knowledge to a formal framework for use in the
development, implementation and evaluation of initiatives
aimed at facilitating the NG transition. In my programme of
research, I have sought to evolve further a substantive theory
of role transition to professional nursing practice by distilling
and distinguishing the salient, unavoidable and necessary
aspects of transition into acute-care nursing from the more
transient, context-related and yielding elements of transition
for which support strategies can be effectively implemented
(Duchscher 2008).

Data sources
The data sources culminating in the generation of this
emerging theory originate from a 10-year programme of
research encompassing four qualitative studies in the area
of new graduate transition and an extensive literature review
of the transition experience of the new NG. The initial study,
conducted in 1998, consisted of a 6-month phenomenological exploration of five new nurses navigating their initial
introduction to professional practice (Duchscher 2001,
2003a). The second study, conducted in 2001, extended

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over a period of 12 months and was an exploration of the

experiences of four new graduates and five seasoned nurses.
These graduates were studied as they integrated into an
emergency room environment immediately after graduating
from a Canadian undergraduate BScN nursing programme
(Duchscher 2003b). The third study was conducted by
Dr Leanne Cowin out of Australia. The author was asked
to complete a retrospective analysis of the qualitative data
collected in this three-part study examining graduate nurse
self-concept and retention plans (Cowin & HengstbergerSims 2004). In the final study, I explored the transition
journey of 15 newly graduated nurses over 18 months from
June 2006 to December 2007 (Duchscher 2007). For this
final study, I employed a generic qualitative approach to data
collection (Sandelowski 2000, Caelli et al. 2003, Rolfe
2006), using a grounded theory process to guide the ongoing
analysis and interpretation of the emerging data. Initial semistructured interview templates were created for the 1, 3, 6, 9,
12 and 18-month data collection periods based on my
previous programme of research on new graduate transition.
These instruments were then modified as the data emerged.
In addition, participants completed preinterview questionnaires and submitted monthly journals detailing their experiences. Finally, focused group discussions, informed and
guided by prior interviews, journaling data and my ongoing
study were conducted during identical time periods with a
separate group of participants originating from the same
nursing programme. A dynamic interplay between inductive
and deductive processes permitted a fluid movement between
data analysis and further data acquisition. Further to the
research conducted, I have reviewed over 1000 publications
related to new graduate transition, hospital nursing and
trends in professional nursing practice, over 400 of which
have been directly related to the transition or integration of
new nurses into work settings. The reviewed documents and
publications were acquired from databases that included
CINAHL Plus, Nursing and Allied Health Collection,
MEDLINE and PsycINFO.

Discussion
Experience of transition shock
Understood in the context of my research, the transition
shock experienced by the NG is embedded within the first
stage of professional role transition (Duchscher 2008). The
stages of professional role transition for the NG reflect a
non-linear process that moves the new practitioner through
developmental and professional, intellectual and emotive,
skill and role-relationship changes, and contains within it

Initial stage of role adaptation for newly graduated Registered Nurses

experiences, meanings and expectations. Further to this, the

experience of transition is presumed to be influenced by
developmental and experiential histories, and situational
contexts that both prescribe and cultivate expectations about
professional roles and responsibilities, work ethic and
culture. The initial professional role transition experience of
the NG is felt with varying intensity, is founded upon
relatively predictable fundamental issues, and exists within
individually motivated and fluctuating states of emotional,
intellectual and physical well-being.
Transition shock emerged as the experience of moving from
the known role of a student to the relatively less familiar role
of professionally practising nurse. Important to this experience for the NG is the apparent contrast between the
relationships, roles, responsibilities, knowledge and performance expectations required within the more familiar academic environment to those required in the professional
practice setting (see Transition Shock Model in Figure 1).
For participants of this research, the experience of transition
shock felt like I just jumped into the deep end of the pool.
Participants seemed ill-prepared for the toll this initial
transition would take on both their personal energy and time
and on their evolving professional self-concepts. Although
they anticipated that some adjustments to their professional
work situation would be necessary, prior to the transition they
never doubted that their choice of career and the investment of
the years of study that this required would be affirmed
through a positive work experience: a welcoming collegial
environment, a moderately challenging but easily achievable
extension to the roles and responsibilities to which they had
grown accustomed, the thrill of actualizing the professional
role to which they had earned the title, and the fulfilment of
being recognized for the knowledge they had acquired and the
commitment they had made to caring for others.
Although this process was neither linear nor prescriptive,
the personal and professional adjustments evolved and
progressed most intensely through the first 14 months
postorientation (the time after which workplace orientation
processes and additional induction learning had taken place
and after the new nurse had been teamed up with a senior
qualified nurse for the purposes of learning expected routines,
roles and responsibilities). At the termination of this postorientation period, the exhaustion and isolation that both fed
and resulted from the disorienting, confusing and doubtridden chaos that represented their new-found reality motivated a deliberate withdrawal from the intensity of the shock
period. The participant expressions of this transition shock
experience are presented here as emotional, physical, sociocultural and -developmental, and intellectual (see Transition
Conceptual Framework in Figure 2).

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Figure 1 Transition Shock Model.

Emotional
The range, overwhelming intensity and labile nature of the
emotions expressed by participants during this initial stage of
transition was truly impressive. Using words and phrases or
expressions such as terrified and scared to death, these
participants claimed that relentless anxieties were routine
during those initial weeks. Although one might expect some
trepidation concerning skill-level competence and the establishment of new collegial relationships in an NG professional,
these data demonstrated that the stability, predictability,
familiarity and consistency of both the introductory clinical
experiences and the individuals with whom the graduates
interacted significantly influenced their responses to the
existing role transition stress. The majority of the graduates
in this research could feel their anxiety dancing on the edges
of my words and memories, displaying overwhelming, and at
times physically and psychologically debilitating, levels of
stress during the initial 14 months postorientation. This
more traumatic adjustment often correlated with inadequate
and insufficient functional and emotional support, lack of
practice experience and confidence, insecurities in communicating and relating to new colleagues, loss of control over
1106

and lack of support for the enactment of their professional

practice values and anticipated roles, physical, emotional,
and intellectual exhaustion, and unrealistic performance
expectations by the institution, their colleagues and the
graduates themselves.
Not uncommonly, participants described dominant nurses
with whom they were required to interact as inadvertently
challenging both the process and content of their practice
foundation. At times, these challenges were perceived as
intentionally seeking to diminish the already negligible level
of confidence with which they were working. Conversely,
some participants poignantly revealed the transforming
capacity of both supportive statements and displays of
acceptance by senior colleagues on the development of their
evolving professional self-concept and on their ability to
pass through the particular moment and keep going.
Interestingly, several participants over the 10-year study
period used the metaphor of drowning when both describing and visually representing the overwhelming experience
of the first 12 months of transition. In the most recent
study, startling pictures were drawn and collages
designed that clearly illustrated the loss of control and

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Initial stage of role adaptation for newly graduated Registered Nurses

Figure 2 Transition Conceptual Framework.

subsequent powerlessness associated with the transition

shock experience.
The energy being consumed by their attempt to stabilize the
emotional roller coaster on which they found themselves
motivated a predictable but nevertheless remarkable exhaustion in all participants by the third to fourth month of
transition. The primary fears for the new graduates during this
stage of their transition were: (1) being exposed as clinically
incompetent, (2) failing to provide safe care to their patients
and inadvertently hurting them and (3) not being able to cope
with their designated roles and responsibilities (see also
Duchscher 2008). The dreaded outcome was rejection by their
peers as valued and contributing members of the professional
community. Understandably, new graduates went to great
lengths to disguise their feelings of inadequacy from their newfound and reverently esteemed colleagues.
The loss of the support system that the NGs employed
during their undergraduate education was intensely felt. Not
having immediate access to previous educators or peers to
provide intellectual counsel, emotional support, or practice
consultation and feedback potentiated the novice practitio-

ners feelings of isolation and self-doubt. Many of their new

graduate colleagues were working different shifts, were
employed in other institutions, or had moved to rural or
distant geographical locations. Access to a support network
of peers and colleagues was identified as an important link
to the ongoing professional development of those who had
even minimal access to it, and sorely missed by those who
did not (see www.nursingthefuture.ca). Finally, many graduates expressed struggles with maintaining the practice
intentions and standards that they had consolidated during
their education. The majority of NGs shared feelings of
frustration and guilt about their inability to enact the
practice principles they believed were a basic requirement of
their professional role. There was a sense of culpability for
the perpetuation of substandard practice that served as a
powerful but insidious role transition de-stabilizer.
Physical
The physical response of the NGs to the transition shock
experience was grounded in the all-encompassing energy
being consumed just trying to perform in their new role at the

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level expected of them without revealing how difficult this

was for them. Changes to established life-pattern routines
such as modified living arrangements, terminated or
advancing intimate relationships, and the acquisition of debt
through the purchase of cars and homes served as both
exciting distractions and unexpected burdens to these already
disoriented graduates. In addition to undergoing personal
and developmental changes, these young professionals were
being expected to make advanced clinical judgments and
practice decisions for which they felt minimally qualified but
completely responsible. The strain of this new level of professional accountability was heightened by unclear practice
expectations from managers and colleagues, inaccurate
assumptions by the graduates of what a successful transition
would look like, unanticipated role-relationship struggles
with colleagues, the physical demands of adjusting to shift
work, and a virtual absence of normalizing feedback on
which to base their experience and their role transition progress. Fed by doubts and insecurities, these new practitioners
seemed unable to control the relentless debriefing of their
practice actions and decisions. They all described spending
their waking hours thinking about what had transpired on
their last shift and preparing for what might happen on their
next one. Sleep time was consumed by dreams about work,
bringing about a state of perpetual work that contributed
significantly to their growing exhaustion.
Sociocultural and developmental
For the young adults in this research, the transition shock
experience was, in large part, about finding their way in a
world for which they had been prepared but were not wholly
ready. The disconnection between who they were as primarily women and young professionals and who they
thought they were supposed to be as nurses, the behaviours
they witnessed in the role models that surrounded them and
how the realities of the practice environment facilitated,
supported, reinforced, challenged or censored professional
codes of behaviour dominated this initial transition period.
During the first 4 months, the primary sociocultural and
developmental tasks for these NGs appeared to be finding
and trusting their professional selves, distinguishing those
selves from the others around them, being accepted by the
larger professional nursing culture, balancing their personal
lives with their professional work, and finding a way to meld
what they had learned during their undergraduate education
with what they were seeing and doing in the real world.
Relationships with colleagues were critical forecasters of the
transition shock experience.
Functioning within a hypersensitive and self-critical state,
the graduates felt any and all tremors of disapproval,
1108

disrespect or doubt as they did likewise of acceptance, praise

or simple encouragement. Regardless of the reasons, most
participants alluded in some way to a desire to be included in
the clique that constituted the culture of their nursing unit.
All spoke of wanting, but not adequately receiving, both
affirming and critical feedback from either their senior
colleagues or those they perceived to be in an evaluative
role, such as managers and educators. In the absence of
formal feedback, these novice practitioners looked for other
indicators by which to measure the safety, competence and
relative progression of their practice. A strong theme during
the initial 4 months of their introduction to professional
practice was the evolution of a more mature, professional
sense of self. This developmental change was both exciting
and daunting to these young people, dictating modifications
to established relationships with friends and family, and
transforming the way in which they viewed themselves.
Several graduate participants talked about growing up, and
reflected on their struggle to renounce the safety and security
of a more protected, comfortable routine and less responsible
way of life.
Graduates spent a good part of the initial transition period
trying to discern their nursing role in relation to others. It was
commonly asserted that being a student, you are doing all
the different roles, so that when you come out youre a little
bit confused. During the initial several months, the NGs
found themselves distracted by the focus on tasks relative to
the other nursing responsibilities with which they associated
their professional role such as patient advocacy, teaching and
counselling. An underdeveloped level of organization and a
desire to fit into the culture of the units where they worked
fostered a focus on completing their tasks on time (e.g.
charting and other paperwork, answering phones, ordering
tests) rather than spending quality time with patients and
families.
Relating to other professionals within the clinical environment was an energy-consuming adjustment. Struggling with
moderate to low levels of self-confidence, these young nurses
found it intimidating and ultimately devaluing to interact
with both senior physicians and nurses whose behaviour
reinforced hierarchical rather than collegial relationships.
Many described an oppressive hierarchy amongst the nursing staff, and passiveaggressive styles of communication
between nurses and physicians. In a related finding, considerable stress was involved in supervising, delegating and
providing direction to other licensed and non-licensed
personnel, many of whom were senior to the NGs in both
practice experience and age. The graduates claimed that they
had never been prepared to take on those roles or allowed to
practise them during their undergraduate education.

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Intellectual
The introduction of the graduates to their new professional
practice environment began with some form of orientation to
the workplace, their nursing role and the context within which
they would be practicing. During this early period, graduates
maintained their high level of energy, eager and inspired by an
exciting anticipation of finally being able to practise independently; being in a learning role was familiar to them and
they held a curious fascination about what lay ahead. Most of
the graduates identified this next step as similar to the
increase in challenge they had long experienced when moving
from one student clinical rotation to another. Additional role
expectations were interpreted as a more advanced conceptual
application of that which they already knew, and as similar to
the graduated progression which had been required of them as
students from year to year. Still not feeling the full weight
of their professional responsibilities or nursing workload
during this orientation period, the clear majority of the study
participants were shocked by the change they experienced
once orientation was completed and they were on their own
in the real world. The experience was rapidly and abruptly
transformed from one of excitement and wonder to one of
overwhelming fear, doubt and all-consuming stress.
Some of the difficulty in making the switch from partial to
full responsibility for these graduates lay in the approach of
senior nurses, clinical educators and nurse managers to
orientation. The majority appeared to have a limited understanding of the relative inflexibility of the NG practice
capabilities and expected that they would be able to manage
the workload of a seasoned practitioner within several weeks.
Further to this, no one mentioned to these participants that
they would experience a transition, nor accounted for that
experience either in the content or process of their professional initiation. Many of the buddy experiences (i.e. often
two 12-hour days and two 12-hour nights where a seasoned
nurse and NG are paired up with a common workload) were
based on workload division rather than on a preceptor-based
tacit knowledge-transfer model. The availability of and
ongoing access to seasoned nursing practitioners varied
considerably in this research. More often than not, graduates
did not reach out to their senior counterparts because the
workloads of the staff to whom they were expected to turn
were as demanding as their own. The feeling that they were
burdening these already-taxed practitioners, combined with
the potential threat to their self-confidence and ultimate
acceptance by their colleagues should they be exposed as
ignorant or inexperienced, served as critical deterrents to
their reaching out for assistance when they needed it.
Without exception, graduates who self-reported that they
had secured an employment position within which they were

Initial stage of role adaptation for newly graduated Registered Nurses

expected to relieve permanent staff on a variety of nursing

units (i.e. floating or casual relief positions) described that
experience as extending, intensifying or delaying progression
through their transition experience, and they suggested that
this work arrangement should not be considered when
introducing NGs to professional practice. For the novice
practitioner, its like a new job every time you go somewhere
new. The primary issue related to floating was the lack of
consistency in both the staff to whom the graduates looked
for mentorship and collegial support, and the patients for
whom they were caring. The influence of these inconsistencies
was further aggravated by a lack of predictability in their
assignments, which prevented them from anticipating and
thus preparing for the unit-related issues, clinical knowledge
expectations and practice requirements of the area to which
they were going.
During the transition shock period, the new nurses were
able to manage reasonably a workload that consisted of a
nursepatient ratio of less than 1:8, a relatively controlled,
balanced and stable level of acuity in their patients, and
practice assignments that provided them with access to
seasoned practitioner-assisted decision-making and clinical
judgment. Several graduates claimed that they were slower
than their colleagues in making decisions and completing
their daily routines. Much time was being spent thinking
back through what was for them relatively linear and
prescriptive theory and instruction from previous undergraduate or current institutional educators. Frequent concerns were expressed about whether or not they were doing
what was expected or what would be considered safe, and
whether or not they would be able to notice that which was
outside of the norm given the intensity of their focus and the
boundaries of their practice experience. A relatively disturbing finding from graduates going through this initial transition shock period was the frequency with which they
expressed concern about being placed in clinical situations
beyond their cognitive or experiential comfort level. Over
30% of those in the final study were either requested to go
to or simply assigned shifts in an observation unit. Some
spoke up, stating their discomfort and even identifying to the
scheduler the perceived impropriety of such an assignment.
Others felt either too new to make demands about their
placements, or interpreted the work placement as a statement of confidence in their abilities, making it difficult to
refuse the request.

Implications for nursing

The transition shock experienced by NGs when they enter
practice as fully functioning professionals contributes to the

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J.E.B. Duchscher

stress and strain of this initial socialization period. Building

on Kramers (1974) earlier work in this area, transition shock
moves us beyond an understanding of the graduates
responses to their new reality as being primarily about a
gap between what they were taught in their undergraduate
education and what they come to know in their work world.
My research demonstrates that the NG engaging in a
professional practice role for the first time is confronted with
a broad range and scope of physical, emotional, sociodevelopmental and -cultural and intellectual changes that are both
expressions of and mitigating factors within the experience of
transition. These factors may be further aggravated by
antecedents related to unfamiliar and changing personal
and professional roles and relationships, unexpected and
enhanced levels of responsibility and accountability that are
unable to be afforded to the graduates during their student
experience, and expectations that they will apply to everyday
practice situations clinical knowledge that has often been
untried, is contextually unrecognizable or is simply unknown.
The element of surprise is an important contributing factor
in the experience of transition shock. While growing evidence
now exists about the effect of various orientation and
transition facilitation programmes on the role socialization
process of the NG (Ward & Berkowitz 2002, Bowles &
Candela 2005, Beecroft et al. 2006, Newhouse et al. 2007),
there is no literature beyond Kramers (1974) work that
demonstrates a relationship between formal pregraduate
transition preparation and the experience of moving into a
professional nursing practice role. The limited scope of
knowledge about professional role transition in undergraduate nursing theory may be contributing to students unfamiliarity with and lack of preparedness for what awaits them
after graduation.
There is an advancing movement towards the development
and enhancement of workplace orientation and transition
facilitation programmes for NGs (Beecroft et al. 2004,
Marcum & West 2004, Gazza & Shellenbarger 2005, Halfer
2007, Newhouse et al. 2007). Although many of these
programmes recognize the issues inherent in the early
experience of the NG, few incorporate formal transition
theory into the content, structure or process of their
programmes. My research suggests that it is important to
further enhance NG orientation programmes by including
knowledge about professional role transition. Such a
programme would encompass knowledge (e.g. theory taught
in creative and interactive ways that accommodate varying
learning styles and modes of knowledge transmission) and
practice (e.g. role playing or contextually based learning
scenarios that engage both novice and seasoned practitioners)
related to the stages of transition and the experience of
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transition shock (e.g. what to expect and when); intergenerational and inter/intraprofessional communication (e.g. work
ethic and style differences as well as role distinctions);
workload delegation and management (e.g. delegating to
individuals older and more experienced than oneself and
prioritizing the competing demands a full workload); lifestyle
adjustment (e.g. financial management and adjustments to
working alternating shifts), change and conflict management
(e.g. dealing with loss and change and navigating evolving
relationships with family, friends and colleagues); unitspecific skills (e.g. special nursing and medical procedures
and emergency protocols); and professional roles and responsibilities (e.g. working with physicians, seasoned nursing
colleagues and multiple disciplines).
In conjunction with important theoretical knowledge and
practical experience, it is suggested that institutions accommodate an evolving programme of mentorship between new
and seasoned practitioners in the workplace (Thomka 2007).
The successful integration of novice nurses into their
collegial network is a primary developmental task of this
socialization period (Etheridge 2007, Newhouse et al. 2007).
Appropriate mentorship supports that allow for changing
roles and relationships between mentor and mentee, and that
correlate with the evolving stages of transition are more
likely to meet the dynamic needs of graduates and may
enhance the job satisfaction of seasoned professionals (Rowe
& Sherlock 2005, Coomber & Barriball 2006, Glasberg
et al. 2007, Duchscher 2008).
In seminal research that explicated the evolving skill
acquisition and competency in nurses as they gained
increased levels of practice experience, Benner (1982; see
also Benner & Wrubel 1982) established that novice nurses
think and act differently from their seasoned counterparts.
More contemporary authors have provided ample evidence
that the critical thought and subsequent clinical judgment of
the NG lacks the depth and breadth that comes with
experience (Taylor 2002, Welk 2002, Roberts & Farrell
2003, Duchscher 2003a). I found similar evidence about the
initial transition shock experience of the NG entering
professional practice during my research and made apparent
the importance of purposefully and slowly graduating the
clinical responsibility and practice autonomy of these novices. My evidence is clear, particularly the data that arose out
of the emergency room research, that choosing to deploy
NGs to acute-care units that require rotations through an
observation or step-down unit, placing new nurses in
permanent floating positions (i.e. relief teams), or staffing
high acuity practice areas (i.e. emergency room or critical
care) with graduates directly out of undergraduate nursing
programmes are decisions that should be undertaken with

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What is already known about this topic

These are challenging times for new nursing graduates,
the majority of whom make their initial transition to
professional practice within the hospital healthcare
environment.
Kramers concept of reality shock, based on research
from the 1960s, continues to serve as the construct
upon which our understanding of the initial transition
to professional practice for new nurses is based.
The contemporary environment within which the newest nursing graduates are making their transition has
changed dramatically in the past 20 years to one where
acute care is intense, highly dynamic and laden with
stress and excessive workload demands.

What this paper adds

Transition shock is presented here as the most immediate, acute and dramatic stage in the process of professional role adaptation for the new nurse.
The concept of transition shock builds on elements of
transition theory, reality shock, cultural and acculturation shock, as well as theory related to professional
role adaptation, growth and development, and change.

Implications for practice and/or policy

Understanding the initial stage of role transition for
newly graduated nurses will assist managers, educators
and seasoned practitioners to appropriately support and
facilitate this professional adjustment.
Healthcare institutions, schools of higher learning and
policy-makers need both to understand and respond to
the issues that may be driving these energetic and
motivated nurses out of acute care, or out of the nursing
profession altogether.
concerted caution, taking into consideration the understandably precarious nature of the NGs cognitive processing
ability during the early stages of their professional socialization period. New graduates should be initially (during the
first 12 months of practice) placed in consistent and relatively
stable clinical settings, be encouraged to increase their
exposure to advanced clinical scenarios gradually and strategically, be given regular and frequent feedback that
reinforces and redirects their developing skill and knowledge,
be offered opportunities for the safe sharing of work
experiences with NG peers as well as seasoned colleagues,

Initial stage of role adaptation for newly graduated Registered Nurses

and be encouraged to collaborate on the development or

enhancement of approaches that optimize their learning
environment and quality work experience.

Conclusion
Transition shock represents the initial reaction by new nurses
to the experience of moving from the protected environment of
academia to the unfamiliar and expectant context of professional practice. The evolving theory presented here depicts the
initial 34 months of professional role transition for the newly
graduated nurse as a process of adjustment that is developmental, intellectual, sociocultural and physical and which is
both motivated and mediated by changing roles, responsibilities, relationships and levels of knowledge in the personal and
professional lives of the new professionals. This theory suggests
that educational institutions and industry employers should
focus on providing preparatory theory about role transition for
senior nursing students, facilitating educational clinical placements that more appropriately prepare graduates for the
dynamic, highly intense and conflict-laden context of professional practice, expand and extend workplace orientations to
offer an alternating balance between theoretical knowledge
and clinical skill practice, and provide structured mentoring
programmes that foster healthy partnerships both between
seasoned and novice nursing practitioners and between nurses
and their multidisciplinary care delivery partners.

Acknowledgements
The author acknowledges Dr Joanne Profetto-McGrath and
Dr Olive Yonge of The University of Alberta Faculty of
Nursing for their continued support and guidance during her
recent doctoral study. The author is additionally grateful to
the SIAST Nursing Division faculty and deans who have
provided her with outstanding support to conduct her
research and writing during the past ten years.

Funding
Sincere appreciation is extended to the Social Science and
Humanities Research Council (SSHRC) for the Canada
Graduate Scholarship that permitted the depth and breadth
of this authors study during the past six years. The author
acknowledges the Saskatchewan Ministry of Health, Canadian Nurses Foundation, Saskatchewan Registered Nurses
Foundation, Izaak Walton Killam Foundation, University of
Alberta Faculty of Nursing and Graduate Studies for their
significant contribution to this scholarship.

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J.E.B. Duchscher

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